Ambrosius, Lisa M

Ambrosius, Lisa M is an individual health care provider with primary practice located at 1715 Dousman St , Green Bay WI 54303-3211. She recently has 2 registered licenses in different health care specialties including Speech, Language and Hearing Service Providers / Speech-Language Pathologist, Speech, Language and Hearing Service Providers / Audiologist. Speech, Language and Hearing Service Providers / Audiologist is her primary health care specialty. Ambrosius, Lisa M can be contacted via phone (920) 405-1414.

Contact Information

Primary practice address
1715 Dousman St Green Bay WI 54303-3211
Phone: (920) 405-1414
Fax: (920) 405-1462
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 1899154 Wisconsin
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 399156 Wisconsin

Profile Details

NPI number 1487632329
LBN Legal business name Ambrosius, Lisa M
Credentials AUD CCCASLP
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 31st, 2005
Last updated Jun 19th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487632329 NPPES
Wisconsin MEDICAID 42782500
Wisconsin MEDICAID 41147800

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